While those medications are good, I think switching to Lexapro 10-20mg is a better option than the Zoloft as Lexapro is more effective, fast acting, and has less side effects

Dr. Z :

Also I would think about combining a low dose of Abilify (5mg) with the Lexapro to increase the effectiveness of the SSRI antidepressant

Dr. Z :

This addition has been proven to be very effective when combined with a SSRI or SNRI antidepressant

Dr. Z :

Also Effexor, Pristiq, and Cymbalta are SNRI antidepressants that are very effective and work very similar to the SSRI antidepressants like Zoloft and Lexapro

Customer:

He takes 200 mg of zoloft and 50 of seroquel at bedtime

Dr. Z :

That is a normal approach with the Seroquel, but studies have shown that Abilify is more effective than Seroquel when added to a SSRI antidepressant for anxiety and depression, so I think that is a better approach

Dr. Z :

The 200mg of the Zoloft is the maximum dosage and usually is a good medication, but studies have shown that Lexapro is better

Customer:

He also takes .5 of xanax once during the day then 2 at bedtime and is still suffering with anxiety and feels very tired during the day

Dr. Z :

And how long has he taken the Zoloft and Seroquel for? The Seroquel is also used as a sleep aid, so it can cause drowsiness

Customer:

Since end of june. He started to feel a little better and was taken off seroquel but put back on it about 3-4 weeks ago when anxiety started getting worse again

Dr. Z :

Yeah the Seroquel at 50mg can cause the drowsiness. Also the Xanax has a sedative factor as well and at 1.5mg a day if he takes 3 x 0.5mg can cause drowsiness too as Xanax has a sedative effect.

Dr. Z :

I think going off the Seroquel and going on the Abilify would be better for your son for his anxiety and to lessen his drowsy feeling

Dr. Z :

Also if his anxiety is still present then switching to Lexapro should be given too

Customer:

What do you say is the best combo for severe anxiety then

Dr. Z :

In addition, switching from Xanax to Klonopin and only using the Klonopin at night can be better for his anxiety and drowsiness during the day because Klonopin has a longer half-life than the Xanax, so if he takes it at night then it will last him for most of the next day (halflife is 20-100 hours).

Customer:

He was on abilify with the zoloft when the seroquel was stopped though

Dr. Z :

The best combination would be for Lexapro 10-20mg and 5mg of the Abilify. But psychotropic medicine is not an exact science as everyone reacts differently to the medicine because our metabolisms are all different. So this is why we have so many different type of antidepressants

Dr. Z :

Oh he was on the Abilify before and it did not work for him, then I would switch him to the Lexapro as this is a stronger medication than the Zoloft

Customer:

So lexapro with the abilify and klonopin

Dr. Z :

That would be my choice for the severe anxiety and to help him not feel drowzy

Dr. Z :

Also is your son in therapy at all too?

Customer:

Yes

Dr. Z :

Okay, I would like to mention that Cognitive Behavioral Therapy (CBT) is the most effective and evidence based therapy to help relieve anxiety symptoms, so if he is not already in that therapy modality you may want to think about going to a therapist that specializes in CBT

Customer:

What are your feelings regarding ativan

Dr. Z :

Ativan and Xanax work very similarly with the same fast acting and short half-life, so there will be no difference with the Ativan

Dr. Z :

Klonopin is also fast acting, but stays in the system longer

Customer:

Also...are you a psychiatrist or psychologist and do you g ave experience in these meds

Dr. Z :

I am a psychologist, but I have a post-graduate degree in Psychopharmacology and I am given prescribing authority in New Mexico and Louisiana

Dr. Z :

So far those are the only two states that allow for Psychologists to do post graduate schooling and get prescribing authority after licensure.

Customer:

Ok I was just curious. So this anxiety is curable. My heart breaks for him

Dr. Z :

Some researchers and therapists do not like to use the word "cure" and prefer "manageable" but I think with CBT and the right medication, it can definitely be curable.

Dr. Z :

I can provide you with some good CBT techniques that can be effective for your son to use for his anxiety if you like

Customer:

Absolutely...

Dr. Z :

CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.

Dr. Z :

So this link may help you, it contains a technique I use with patients called a thought record. It will help him keep track of any negative thoughts he has. He puts the negative thought on paper, the emotion accompanying, the evidence to support it, and the evidence against it. Then I want him to come up with an alternative thought for the situation (more objective and plausible). This will help him change his way of thinking to be able to think more positive and not automatically go to a negative type of thinking.

This is a link for something called Progressive Muscle Relaxation that can help him create a long term calm by using muscle tension and release techniques; it can help manage his anxiety and is very similar to a style of meditation.

When the anxiety is bad it is all you can think about at the time but I will have him do what you recommend

Dr. Z :

I understand, CBT therapy, like most therapies, are a gradual approach and it takes time for it to be effective. The medication will help lessen his symptoms, but the therapy will actually "cure" him.

Dr. Z :

This is why using them together is a good treatment combination

Customer:

Great...thank you

Dr. Z :

Anytime, I am always happy to help. I hope your son truly feels better soon and that his anxiety lessens. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer:

How do I contact you

Dr. Z :

Well you can go always go back to this chat for follow up questions at no cost to you. Now if you have future questions, you can request me by putting "For DoctorZ only" before the question

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

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I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly.
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